Suyapa Mariel Jackson, NP is a
Nurse Practitioner - Primary Care based in Tontitown, Arkansas. Suyapa Mariel Jackson is licensed to practice in Mississippi (license number 906658) and her current practice location is
1523 Padova Ave, Tontitown, Arkansas. She can be reached at her office (for appointments etc.) via phone at
(601) 209-9031.
NPI number for Suyapa Mariel Jackson is 1659105195 and her current mailing address is 1523 Padova Ave, Tontitown, Arkansas. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1659105195.
Provider's Profile
| Full Name | Suyapa Mariel Jackson |
|---|
| Gender | Female |
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| Speciality | Nurse Practitioner - Primary Care |
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| Location | 1523 Padova Ave, Tontitown, Arkansas |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1659105195
- Provider Enumeration Date: 08/28/2024
- Last Update Date: 08/28/2024
Medical Identifiers
Medical identifiers for Suyapa Mariel Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1659105195 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LA2200X | Nurse Practitioner - Adult Health | 906658 (Mississippi) | Secondary |
| 363LG0600X | Nurse Practitioner - Gerontology | 906658 (Mississippi) | Secondary |
| 363LP2300X | Nurse Practitioner - Primary Care | 906658 (Mississippi) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Suyapa Mariel Jackson is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Suyapa Mariel Jackson, NP
1523 Padova Ave,
Tontitown, AR 72762-5386
Ph: (601) 209-9031 | Suyapa Mariel Jackson, NP
1523 Padova Ave,
Tontitown, AR 72762-5386
Ph: (601) 209-9031 |
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